| NPI | 1134147978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101055642) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D51741) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MD D51741) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-07 |